N.H. prepares for changes in addiction treatment

Tuesday

Apr 23, 2013 at 3:15 AM

HOLLY RAMERAssociated Press

CONCORD (AP) — Thousands of New Hampshire residents with drug and alcohol problems will become eligible for insurance coverage next year under the new health care overhaul, and providers and advocates are both optimistic about opportunities and realistic about challenges.

The number of people seeking treatment nationwide could double over current levels, potentially swamping an already stressed system, an Associated Press analysis of government data found. In New Hampshire, only 6,000 of the estimated 113,000 people who need treatment are getting it, and the 329 beds at residential treatment facilities and hospitals are often full, according to federal data.

In January, the number of people with drug and alcohol problems who will be newly eligible for insurance will be roughly 11,770, — or 19,500 if the state also expands its Medicaid program, according to the AP analysis of data on addiction rates, the capacity of treatment programs and the provisions of the new health law.

That is a huge change, but the effects won't show up overnight, in large part because a lack of insurance is not the only reason someone might not seek treatment, said Timothy Rourke, chairman of the Governor's Commission on Alcohol and Other Drug Abuse Prevention, Intervention and Treatment. He pointed to the experience of other states that already have laws requiring substance abuse treatment to be covered the same way as other medical procedures.

"It doesn't create a crushing wave all at once that overwhelms the existing system. It appears to be more of a trickle than a flood," he said.

Rourke does expect the numbers to increase over time as addiction treatment services move "out of the shadows" of specialty care into mainstream medicine. And efforts are underway to both prepare existing agencies and explore opportunities for expansion, he said.

"Certainly we need to be ready for it, but I don't necessarily think we need to be ready for it Jan. 1," he said.

New Hampshire's current treatment system is small, and the state spends very little public money on it — $1.5 million a year, said Amy Pepin, policy director for the advocacy group New Futures. Waiting lists to get into treatment are common, and there is no comprehensive system aimed at prevention and early identification of problems like there is for other chronic diseases like diabetes. The state is trying to move toward what's called a recovery-oriented system of care, which recognizes that people dealing with addiction need support over time, but budget constraints have hampered those efforts.

"Access to care is usually at a crisis point," she said. "Which isn't appropriate. That's just the acute part of treatment, but it needs to continue after that."

Abby Borgeois, director of the New Hampshire Alcohol and Other Drug Service Providers Association, said the state has a strong network of providers but they've been severely affected by budget cuts. Many are funded by grants, which have been diminishing.

"Medicaid expansion and the Affordable Care Act really provide some immense opportunities for providers and the people they serve. But I think with that opportunity also comes challenges," she said. "As an association and as a network of providers, we're really working hard to help our agencies build the capacity they need to respond to the expected changes."

Much of the focus over the last year has been helping agencies prepare for the shift from a grant-funded model to a fee-for-service billing model, she said.

"There's a good understanding that it is a work in progress, but we're trying to do the best we can with what we know, and we do at least have the scope and resources to get the agencies started down the road to be doing this in the future," she said. "You have to be optimistic about it. Of course we understand there are going to be challenges, but we'll take those in stride and learn from them and work through them."